Quarantine

BIOTERRORBIBLE.COM:In
the wake of a bio-terror attack and subsequent pandemic, people will likely be
quarantined under martial law
and sent to FEMA concentration camps
via human cattle cars
where they will likely be exterminated in mass. Quarantine will be the excuse
given as the government orders the removal of citizens from their homes and
properties.

Title: Where Would Bioterrorism Victims Be Quarantined?Date: September 22, 2002Source: Seattle Times

Abstract: The state's
plan to deal with bioterrorism details the powers of local health officers to
quarantine victims of an attack, but fails to answer a critical question: Where
would all those people go?

Nowhere in the proposed new rules
-- issued by the state Board of Health on the first anniversary of Sept. 11 --
or in existing law does it say how a local health officer would go about
confiscating a building, such as a hospital, hotel or other business to house
those with a dangerously contagious disease.

And after nearly a year of
discussions, no local hospital has agreed to be designated as the place where
large numbers of infectious patients could be isolated, despite the guideline
from the federal Centers for Disease Control and Prevention (CDC) that local
planners designate such a facility before it is needed.

Dr. Alonzo Plough, head of Public
Health -- Seattle & King County, says hospital CEOs don't doubt that local
health officers have the power to take over a facility.

During the year, hospitals and
public-health officials have worked with "great cooperation and
collegiality," Plough said, toward a collaborative regional plan for the
care of infectious patients.

But hospitals here
and around the country continue to voice concerns, many of them economic, about
being designated "the" smallpox hospital.

"The hospitals are very
reluctant to stand up and say, 'Pick me!' " said Dr. Nancy Auer, vice
president of medical affairs for Swedish Medical Center, which operates three
hospital campuses in Seattle.

Signing up to be the smallpox
isolation and care facility, she said, amounts to signing up to turn away all
surgery and immune-suppressed patients, which would include those receiving
chemotherapy or organ transplants. The financial impact? "It's enormous," Auer said.

Compensation for lost
revenue isn't addressed, she said. "I
don't even think there's a (billing) code for smallpox. You could pick 'rash.'
Well, there's a big winner."

The Board of Health's plan
attempts to pull together outdated laws, codes and rules and meld them with
modern due-process protections, such as rights to hearings and appeals.

Dr. Tom Locke, state Board of
Health member, acknowledges that clear procedures for "commandeering and
expropriating facilities" also are necessary in a comprehensive bioterror
response plan. "Where you
isolate them, where you quarantine them, is an issue -- it's an inescapable
issue."

But for now, the
board is not addressing the touchy subject head-on. "You have to establish
priorities," Locke said. Besides, he said, the process will work better if
a voluntary agreement can be reached.

"We don't want
to stage an armed assault of a major urban hospital," said Locke, who also
is health officer for Jefferson and Clallam counties. "That's a failure of planning."

In the back of everyone's mind,
though: What if "something" happens before there is an agreement?
Plough will say only that there's been good progress. "We need a coherent
King County plan, which we're marching toward."

Similar Situations

These are sensitive discussions,
and local health officials all around the country have been struggling to work
out agreements, said Dr. Joanne Cono of the CDC's Bioterrorism Preparedness and
Response Program. "What's going on in Seattle is not at all unusual,"
Cono said. "People are working hard on this, and it hasn't been an easy
situation."

Health officials say no hospital
in the nation has agreed publicly to take large numbers of infectious patients.

At first, some observers assumed
Harborview Medical Center, the county hospital, would be the prime candidate
here. But CDC guidelines say a designated facility should not be used for any
other purpose, and Harborview is the only hospital in the region that can
handle the highest level of trauma cases.

Recently, an intriguing option
has surfaced: Some hospital administrators are looking at the federally owned
Veterans Hospital in Seattle and Madigan hospital at Fort Lewis.

"Looking
at?" said one hospital official. "With binoculars!"

This state, like
others, drew from the "Model State Emergency Health Powers Act"
circulated by the CDC in late 2001 as a template for state bioterror rules.
Washington, however, did not adopt its "control of property" section.

That section says the
public-health authority can immediately take over a health-care facility if
deemed "reasonable and necessary" for emergency response.

Locke said he doesn't like such
"one-size-fits-all" rules.

"In Seattle, it will
probably involve taking whole hospitals or whole hospital communities as a
place for the very acutely ill. In Sequim or Port Angeles, you can't commandeer
the hospital, because it's the only one. It would have to be a hotel or some
other place."

State of Emergency

Although Washington law does not
address specifically the right of officials to confiscate facilities, or
outline the procedure, Senior Assistant Attorney General Joyce Roper said the
governor has broad powers under a declaration of emergency. Local health
officers also have broad authority to "control and prevent the spread of
any dangerous, contagious or infectious diseases that may occur within his or
her jurisdiction."

Because the liberty
of individuals is constitutionally protected, the state needed to spell out
due-process rights in the rules for isolation and quarantine, Roper said. But
taking over a hospital -- and the economic impact -- is a different matter.

However, a Washington
state court case on compensation for an emergency confiscation, though not of a
hospital, is on appeal. "We'll see if the court says we were right or
wrong," Roper said.

So for now, the state
Board of Health plans to stay narrowly focused on questions surrounding
isolation and quarantine of individuals.

Regarding the
proposed rules on quarantine and isolation, the state is generally going in the
right direction, said Roger Leishman, an attorney who reviewed the plan for the
American Civil Liberties Union.

For example, while a
health officer has the power to order someone into quarantine for 10 days, the
person has the right to a court hearing within 72 hours of requesting one.

But Leishman and
others say draft language is sometimes overly broad. For example, the
definition of "contaminated," he said, covers any material posing
long-term health hazards.

"Nutrasweet or cigarettes
fall under that definition," he said.

Leishman doesn't expect the
Health Department to start slapping smokers into isolation. "But the
problem is when you use language that's that broad, it could be used down the road.
... The real goal here should be to have the words say what they mean, to give
clear guidance to health professionals trying to do their job."

In other sections,
the draft specifies that a quarantined person who becomes infected with a
"communicable or possibly communicable disease" must be promptly
placed in isolation.

"Someone
quarantined because they've been exposed to biological threats shouldn't be
placed in isolation because they have a cold or Hepatitis C," Leishman
said.

Another section tries
to respect religious beliefs, saying that people have the right to rely on
"spiritual means" to treat a communicable disease. But it limits
those rights to those who ascribe to a "well-recognized church or
religious denomination."

"We should be
careful to accommodate even religious beliefs that are out of the
mainstream," Leishman said.

Ken Wing, a professor
of health law at Seattle University, says rules like this need to be very
clear. "If you're holding it up to the light and trying to figure out what
they're trying to do, that's not good," he said. "Just having good
motives is not enough."

For now, Plough and
Locke say they're forging ahead with the hospital administrators, ironing out
other parts of a bioterrorism readiness plan.

They hope the process will result
in voluntary solutions. And if that doesn't happen?

"If we find we're unable to
get that sort of cooperation, what all parties think is a viable plan, we could
be looking to new authority to commandeer facilities," Locke said.
"It may come to that. We haven't crossed that bridge yet" (Seattle Times, 2002).